Preoperative peak expiratory flow (PEF) for predicting postoperative pulmonary complications after lung cancer lobectomy: a prospective study with 725 cases

Yutian Lai, Xin Wang, Pengfei Li, Jue Li, Kun Zhou, Guowei Che


Background: The study aimed to investigate the correlation between peak expiratory flow (PEF) and postoperative pulmonary complications (PPCs) for lung cancer patients undergoing lobectomy.
Methods: Patients who were diagnosed with resected non-small cell lung cancer (NSCLC) (n=725) were prospectively analyzed and the relationship between the preoperative PEF and PPCs was evaluated based on patients’ basic characteristics and clinical data in hospital
Results: Among the 725 included patients, 144 of them were presented PPCs in 30 days after lobectomy, which were divided into PPCs group. PEF value (294.2±85.1 vs. 344.7±89.6 L/min; P<0.001) were found lower in PPCs group, compared with non-PPCs group; PEF (OR, 0.984, 95% CI: 0.980–0.987, P<0.001) was a significant independent predictor for the occurrence of PPCs; based on an receiver operating characteristic (ROC) curve, with the consideration of balancing the sensitivity and specificity, a cutoff value of 300 (L/min) (Youden index: 0.484, sensitivity: 69.4%, specificity: 79.0%) was selected and a PEF ≤300 L/min indicated a 8-fold increase in odds of having PPCs after lung surgery (OR, 8.551, 95% CI: 5.692–12.845, P<0.001). With regard to PPCs rate, patients with PEF value ≤300 L/min had high PPCs rate than those with PEF >300 L/min (45.0%, 100/222 vs. 8.7%, 44/503, P<0.001); Meanwhile, pneumonia (24.8%, 55/222 vs. 6.4%, 32/503, P<0.001), atelectasis (9.5%, 21/222 vs. 4.0%, 20/503, P=0.003) and mechanical ventilation >48 h (5.4%, 12/222 vs. 2.4%, 12/503, P=0.036) were higher in the group with PEF value ≤300 L/min.
Conclusions: The presented study revealed a significant correlation between a low PEF value and PPCs in surgical lung cancer patients receiving lobectomy, indicating the potential of a low PEF as an independent risk factor for the occurrence of PPCs and a PPC-guided (PEF value ≤300 L/min) risk assessment could be meaningful for the perioperative management of lung cancer candidates waiting for surgery.